Displaying publications 1 - 20 of 47 in total

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  1. Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M
    JAMA, 2012 Oct 17;308(15):1566-72.
    PMID: 23073953 DOI: 10.1001/jama.2012.13356
    Administration of traditional chloride-liberal intravenous fluids may precipitate acute kidney injury (AKI).
    Matched MeSH terms: Fluid Therapy/adverse effects*
  2. Yunos NM, Bellomo R, Taylor DM, Judkins S, Kerr F, Sutcliffe H, et al.
    Emerg Med Australas, 2017 Dec;29(6):643-649.
    PMID: 28597505 DOI: 10.1111/1742-6723.12821
    OBJECTIVE: Patients commonly receive i.v. fluids in the ED. It is still unclear whether the choice of i.v. fluids in this setting influences renal or patient outcomes. We aimed to assess the effects of restricting i.v. chloride administration in the ED on the incidence of acute kidney injury (AKI).

    METHODS: We conducted a before-and-after trial with 5008 consecutive ED-treated hospital admissions in the control period and 5146 consecutive admissions in the intervention period. During the control period (18 February 2008 to 17 August 2008), patients received standard i.v. fluids. During the intervention period (18 February 2009 to 17 August 2009), we restricted all chloride-rich fluids. We used the Kidney Disease: Improving Global Outcomes (KDIGO) staging to define AKI.

    RESULTS: Stage 3 of KDIGO-defined AKI decreased from 54 (1.1%; 95% confidence interval [CI] 0.8-1.4) to 30 (0.6%; 95% CI 0.4-0.8) (P = 0.006). The rate of renal replacement therapy did not change, from 13 (0.3%; 95% CI 0.2-0.4) to 8 (0.2%; 95% CI 0.1-0.3) (P = 0.25). After adjustment for relevant covariates, liberal chloride therapy remained associated with a greater risk of KDIGO stage 3 (hazard ratio 1.82; 95% CI 1.13-2.95; P = 0.01). On sensitivity assessment after removing repeat admissions, KDIGO stage 3 remained significantly lower in the intervention period compared with the control period (P = 0.01).

    CONCLUSION: In a before-and-after trial, a chloride-restrictive strategy in an ED was associated with a significant decrease in the incidence of stage 3 of KDIGO-defined AKI.

    Matched MeSH terms: Fluid Therapy/methods*; Fluid Therapy/standards*
  3. Yoshida, Teruaki, Zarinah Waheed, Mohd Yusof Ibrahim, Mohammad Illzam Elahee, Shahjee Hussain, Sharifa Mariam Uma Abdullah, et al.
    MyJurnal
    Food related disease or food poisoning is prevalent worldwide and is associated with high mortality. It can be caused by bacteria, viruses, parasites, enterotoxins, mycotoxins, chemicals, histamine poisoning (scombroid) ciguatera and harmful algal bloom (HAB). Illness can also result by red tide while breathing in the aerosolized brevitoxins (i.e. PbTx or Ptychodiscus toxins). Bacterial toxin food poisoning can affect within 1-6 hours and 8-16 hours, and illness can be with or without bloody diarrhea. The common symptoms of food poisoning include abdominal cramps, vomiting and diarrhea. Diagnosis includes examination of leftover food, food preparation environment, food handlers, feces, vomitus, serum and blood. Treatment involves oral rehydration, antiemetic, and anti-peristaltic drugs. Antimicrobial agents may be needed in the treatment of shigellosis, cholera, lifesaving invasive salmonellosis and typhoid fever. Proper care in handling and cooking is important to prevent any food borne diseases.
    Matched MeSH terms: Fluid Therapy
  4. Vilhena-Franco T, Mecawi AS, Elias LL, Antunes-Rodrigues J
    J Endocrinol, 2016 Nov;231(2):167-180.
    PMID: 27613338
    Water deprivation (WD) induces changes in plasma volume and osmolality, which in turn activate several responses, including thirst, the activation of the renin-angiotensin system (RAS) and vasopressin (AVP) and oxytocin (OT) secretion. These systems seem to be influenced by oestradiol, as evidenced by the expression of its receptor in brain areas that control fluid balance. Thus, we investigated the effects of oestradiol treatment on behavioural and neuroendocrine changes of ovariectomized rats in response to WD. We observed that in response to WD, oestradiol treatment attenuated water intake, plasma osmolality and haematocrit but did not change urinary volume or osmolality. Moreover, oestradiol potentiated WD-induced AVP secretion, but did not alter the plasma OT or angiotensin II (Ang II) concentrations. Immunohistochemical data showed that oestradiol potentiated vasopressinergic neuronal activation in the lateral magnocellular PVN (PaLM) and supraoptic (SON) nuclei but did not induce further changes in Fos expression in the median preoptic nucleus (MnPO) or subfornical organ (SFO) or in oxytocinergic neuronal activation in the SON and PVN of WD rats. Regarding mRNA expression, oestradiol increased OT mRNA expression in the SON and PVN under basal conditions and after WD, but did not induce additional changes in the mRNA expression for AVP in the SON or PVN. It also did not affect the mRNA expression of RAS components in the PVN. In conclusion, our results show that oestradiol acts mainly on the vasopressinergic system in response to WD, potentiating vasopressinergic neuronal activation and AVP secretion without altering AVP mRNA expression.
    Matched MeSH terms: Fluid Therapy
  5. Usman A, Makmor Bakry M, Mustafa N, Rehman IU, Bukhsh A, Lee SWH, et al.
    Diabetes Metab Syndr Obes, 2019;12:1323-1338.
    PMID: 31496770 DOI: 10.2147/DMSO.S208492
    Background: During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events.

    Objective: To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA.

    Methodology: Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale.

    Results: Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level.

    Conclusion: The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.
    Matched MeSH terms: Fluid Therapy
  6. Tan PC, Norazilah MJ, Omar SZ
    Obstet Gynecol, 2013 Feb;121(2 Pt 1):291-298.
    PMID: 23232754 DOI: 10.1097/AOG.0b013e31827c5e99
    OBJECTIVE: To compare 5% dextrose-0.9% saline against 0.9% saline solution in the intravenous rehydration of hyperemesis gravidarum.

    METHODS: Women at their first hospitalization for hyperemesis gravidarum were enrolled on admission to the ward and randomly assigned to receive either 5% dextrose-0.9% saline or 0.9% saline by intravenous infusion at a rate 125 mL/h over 24 hours in a double-blind trial. All participants also received thiamine and an antiemetic intravenously. Oral intake was allowed as tolerated. Primary outcomes were resolution of ketonuria and well-being (by 10-point visual numerical rating scale) at 24 hours. Nausea visual numerical rating scale scores were obtained every 8 hours for 24 hours.

    RESULTS: Persistent ketonuria rates after the 24-hour study period were 10 of 101 (9.9%) compared with 11 of 101 (10.9%) (P>.99; relative risk 0.9, 95% confidence interval 0.4-2.2) and median (interquartile range) well-being scores at 24 hours were 9 (8-10) compared with 9 (8-9.5) (P=.73) in the 5% dextrose-0.9% saline and 0.9% saline arms, respectively. Repeated measures analysis of variance of the nausea visual numerical rating scale score as assessed every 8 hours during the 24-hour study period showed a significant difference in favor of the 5% dextrose-0.9% saline arm (P=.046) with the superiority apparent at 8 and 16 hours, but the advantage had dissipated by 24 hours. Secondary outcomes of vomiting, resolution of hyponatremia, hypochloremia and hypokalemia, length of hospitalization, duration of intravenous antiemetic, and rehydration were not different.

    CONCLUSIONS: Intravenous rehydration with 5% dextrose-0.9% saline or 0.9% saline solution in women hospitalized for hyperemesis gravidarum produced similar outcomes.

    CLINICAL TRIAL REGISTRATION: ISRCTN Register, www.controlled-trials.com/isrctn, ISRCTN65014409.

    LEVEL OF EVIDENCE: I.

    Matched MeSH terms: Fluid Therapy*
  7. Tan PC, Norazilah MJ, Omar SZ
    Obstet Gynecol, 2013 Jun;121(6):1360.
    PMID: 23812475 DOI: 10.1097/AOG.0b013e31829395ef
    Matched MeSH terms: Fluid Therapy*
  8. Tan AH, Lim SY, Ng RX
    JAMA Neurol, 2018 07 01;75(7):888-889.
    PMID: 29799978 DOI: 10.1001/jamaneurol.2018.0983
    Matched MeSH terms: Fluid Therapy/adverse effects*
  9. Sue Shan, L., Sulaiman, R., Sanny, M., Nur Hanani, Z.A.
    MyJurnal
    The aim of this study was to evaluate the effect of barrel temperature and flour types on the residence time and physical properties of various flour extrudates. Corn flour, rice flour, corn flour with potato starch (30% w/w, d.b), and rice flour with potato starch (30%w/w, d.b) were extruded at screw speed of 75rpm, feed moisture at 25% (w/w, w.b.), barrel temperature ranging from 80°C to 140°C and die size of 1.88mm. The extrudates were dried at 50°C overnight and further analysed. Results showed that an increase in extruder barrel temperature decreased the residence time of the flours in the extruder (from 4.11-11.32min to 2.24-6.76min), but increased the expansion ratio, rehydration ratio, water absorption index, water solubility index and b value of the extrudate (p≤0.05). The extrudates had the mean residence time and physical properties of rice flour
    Matched MeSH terms: Fluid Therapy
  10. Sreeramareddy CT, Low YP, Forsberg BC
    BMC Pediatr, 2017 03 21;17(1):83.
    PMID: 28320354 DOI: 10.1186/s12887-017-0836-6
    BACKGROUND: Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries.

    METHODS: We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys.

    RESULTS: Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%.

    CONCLUSIONS: Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.

    Matched MeSH terms: Fluid Therapy/methods; Fluid Therapy/standards; Fluid Therapy/trends*; Fluid Therapy/utilization
  11. Singh R, Brouns F, Kovacs E
    PMID: 12236441
    The effects of 7.6% carbohydrate-electrolyte solution (CES) and placebos (P) on rehydration (R) after exercise-induced dehydration and on a subsequent time-trial (TT) of cycling performance were studied. Thirteen male subjects exercised in a thermally-controlled environment (28 degrees C, 63% RH) until 3% of their body weight was lost. After exercise, the subjects moved to a neutral environment (22 degrees C) and rested for 30 minutes prior to a 2-hour R period. During R, subjects were fed CES or P to a maximum volume of 120% of previous body mass loss at 0, 30, and 60 minutes, in bolus-doses of 50%, 40% and 30% respectively. After R, subjects performed a 1-hour TT with no further fluid intake. % R with CES was significantly higher than with P (70 +/- 3% vs 60 +/- 5%; p < 0.01). During the TT, blood glucose dropped in the CES group but not in the P group. It was found that, despite a more effective R with CES, the performance results did not differ between groups (65.1 +/- 2.2 minutes and 65.2 +/- 2.3 minutes for CES and P respectively). It is suggested that an insulin-mediated rebound effect on CHO metabolism during TT, in which no further CHO was supplied, nullified the benefits of rehydration.
    Matched MeSH terms: Fluid Therapy*
  12. Shaw DD, Jacobsen CA, Konare KF, Isa AR
    Med J Malaysia, 1990 Dec;45(4):304-9.
    PMID: 2152051
    A community based study was conducted on the understanding and knowledge of childhood diarrhoea and use of oral rehydration therapy (ORT), in four selected villages in Tumpat District, Kelantan. The calculated annual incidence of diarrhoeal disease in children aged 0 to four years in all study villages was 1.38 episodes for each child. The main care-givers of children aged 0 to four years were interviewed and asked to demonstrate how to mix a standard ORS (oral rehydration solution) sachet if they had previously used ORT. Forty percent of care-givers had heard of the locally available ORT and 30% had actually used ORT. Of those who had heard of or used ORT, 10% had good knowledge of what it was and what it was used for, 51% had some knowledge and 39% had either no knowledge or inaccurate knowledge. Of care-givers who had previously used ORT only 20.5% demonstrated the correct volume of water to add to one sachet of ORT, but 82% would discard an unused solution within 24 hours. Significantly more literate women had used ORT than those not literate (p = 0.002). Mothers, particularly those literate, are the primary target group for ORT intervention strategies. Components of health education should include advice on what ORS is, what it is used for, and how to correctly mix a standard sachet.
    Matched MeSH terms: Fluid Therapy*
  13. Shaik Farid AW, Mohd Hashairi F, Nik Hisamuddin NA, Chew KS, Rashidi A
    Med J Malaysia, 2013 Dec;68(6):465-8.
    PMID: 24632914 MyJurnal
    According to the class of hypovolaemic shock, a blood loss less than 750 ml is not associated with the physiological changes. As a result it may cause a delay in fluid resuscitation. We postulate inferior vena cava (IVC) diameter reduction in inspiration and expiration may resemble the significant volume of blood loss in a healthy adult. We conducted a study to examine the changes of the IVC diameter pre and post blood donation.The inferior vena cava diameter during inspiration (IVCi) and expiration (IVCe) were measured using ultrasound (GE HEALTH) in supine position before and after blood donation of 450 ml. Paired t-test and Wilcoxin rank test were used to analyse the data. Forty two blood donors enrolled during the study period. The mean age of blood donors was 32.3 +/- 8.9 and mainly male blood donors. The mean IVCe of pre and post blood donation was 18.5 +/- 6.2 mm (95%CI 18.23, 18.74) and 16.6 +/- 6.6 mm (95%CI 16.35, 16.76) respectively. Meanwhile, the mean IVCi of pre and post blood donation was 17.1 +/- 8.6 mm (95%CI 16.89,17.30) and 15.6 +/- 6.6 mm (95%CI 15.43,15.81) respectively. The mean difference of IVCe pre and post blood donation was 1.9 +/- 0.5 mm (95%CI 1.75, 2.13) (p<0.001). In contrast, the mean difference of IVCi pre and post blood donation was 1.5 +/- 0.5 mm (95%CI 1.34, 1.68) (p<0.001). As a conclusion, the measurement of IVC diameter by ultrasound can predict the volume of blood loss in simulated type 1 hypovolaemia patient.
    Matched MeSH terms: Fluid Therapy
  14. Saat M, Singh R, Sirisinghe RG, Nawawi M
    J Physiol Anthropol Appl Human Sci, 2002 Mar;21(2):93-104.
    PMID: 12056182
    This is to cross-over study to assess the effectiveness of fresh young coconut water (CW), and carbohydrate-electrolyte beverage (CEB) compared with plain water (PW) for whole body rehydration and blood volume (BV) restoration during a 2 h rehydration period following exercise-induced dehydration. Eight healthy male volunteers (mean age and VO2max of 22.4 +/- 3.3 years and 45.8 +/- 1.5 ml min kg-1 respectively) exercised at 60% of VO2max in the heat (31.1 +/- 0.03 degrees C, 51.4 +/- 0.1% rh) until 2.78 +/- 0.06% (1.6 +/- 0.1 kg) of their body weight (BW) was lost. After exercise, the subjects sat for 2 h in a thermoneutral environment (22.5 +/- 0.1 degrees C; 67.0 +/- 1.0% rh) and drank a volume of PW, CW and CEB on different occasions representing 120% of the fluid loss. A blood and urine sample, and the body weight of each subject was taken before and after exercise and at 30 min intervals throughout a rehydration period. Each subject remained fasted throughout rehydration. Each fluid was consumed in three portions in separate trials representing 50% (781 +/- 47 ml), 40% (625 +/- 33 ml) and 30% (469 +/- 28 ml) of the 120% fluid loss at 0, 30 and 60 min of the 2 h rehydration period, respectively. The drinks given were randomised. In all the trials the subjects were somewhat hypohydrated (range 0.08-0.18 kg BW below euhydrated BW; p > 0.05) after a 2 h rehydration period since additional water and BW were lost as a result of urine formation, respiration, sweat and metabolism. The percent of body weight loss that was regained (used as index of percent rehydration) during CW, PW, and CEB trials was 75 +/- 5%, 73 +/- 5% and 80 +/- 4% respectively, but was not statistically different between trials. The rehydration index, which provided an indication of how much of what was actually ingested was used for body weight restoration, was again not different statistically between trials (1.56 +/- 0.14, 1.36 +/- 0.13 and 1.71 +/- 0.21 for CW, CEB and PW respectively). Although BV restoration was better with CW, it was not statistically different from CEB and PW. Cumulative urine output was similar in all trials. There were no difference at any time in serum Na+ and Cl-, serum osmolality, and net fluid balance between the three trials. Urine osmolality decreased after 1 h during the rehydration period and it was lowest in the PW trial. Plasma glucose concentrations were significantly higher compared with PW ingestion when CW and CEB were ingested during the rehydration period. CW was significantly sweeter, caused less nausea, fullness and no stomach upset and was also easier to consume in a larger amount compared with CEB and PW ingestion. In conclusion, ingestion of fresh young coconut water, a natural refreshing beverage, could be used for whole body rehydration after exercise.
    Matched MeSH terms: Fluid Therapy*
  15. Rosenberger KD, Lum L, Alexander N, Junghanss T, Wills B, Jaenisch T, et al.
    Trop Med Int Health, 2016 Mar;21(3):445-53.
    PMID: 26752720 DOI: 10.1111/tmi.12666
    OBJECTIVE: Clinical management of dengue relies on careful monitoring of fluid balance combined with judicious intravenous (IV) fluid therapy. However, in patients with significant vascular leakage, IV fluids may aggravate serosal fluid accumulation and result in respiratory distress.
    METHODS: Trained physicians followed suspected dengue cases prospectively at seven hospitals across Asia and Latin America, using a comprehensive case report form that included daily clinical assessment and detailed documentation of parenteral fluid therapy. Applying Cox regression, we evaluated risk factors for the development of shock or respiratory distress with fluid accumulation.
    RESULTS: Most confirmed dengue patients (1524/1734, 88%) never experienced dengue shock syndrome (DSS). Among those with DSS, 176/210 (84%) had fluid accumulation, and in the majority (83%), this was detectable clinically. Among all cases with clinically detectable fluid accumulation, 179/447 (40%) were diagnosed with shock or respiratory distress. The risk for respiratory distress with fluid accumulation increased significantly as the infused volume over the preceding 24 h increased (hazard ratio 1.18 per 10 ml/kg increase; P < 0.001). Longer duration of IV therapy, use of a fluid bolus in the preceding 24 h, female gender and poor nutrition also constituted independent risk factors.
    CONCLUSIONS: Shock and respiratory distress are relatively rare manifestations of dengue, but some evidence of fluid accumulation is seen in around 50% of cases. IV fluids play a crucial role in management, but they must be administered with caution. Clinically and/or radiologically detectable fluid accumulations have potential as intermediate severity endpoints for therapeutic intervention trials and/or pathogenesis studies.
    KEYWORDS: IV fluid therapy; clinical spectrum; dengue; espectro clínico; fluidothérapie IV; fuga vascular; fuite vasculaire; prospectif; prospective; prospectivo; spectre clinique; terapia IV de fluidos; vascular leakage
    Matched MeSH terms: Fluid Therapy*
  16. Reddy VG
    Med J Malaysia, 1999 Mar;54(1):132-45.
    PMID: 10972019
    Acute respiratory distress syndrome (ARDS) has been associated with high mortality. Improved understanding of the pathophysiology, recognition of precipitating events and improved management has decreased the mortality over the years. Mechanical ventilation is still the corner stone of the management of the disease. It is well recognised that high tidal volumes and airway pressures increase the morbidity, hence the need to use alternative modes of ventilation like pressure control with or without inverse ratio ventilation. Extracorporeal membrane oxygenation is still experimental and not easily available, whereas prone position to improve oxygenation is simple and inexpensive. The concept of pathological oxygen dependency and therapy aimed at supranormal values has failed to improve survival. Restricting the fluids to prevent further oedema formation in an already wet lung has improved the survival rate. Nitric oxide and surfactant have failed to produce desirable effect in large studies. Pharmacological support to inhibit inflammation with non steroidal anti-inflammatory drugs, antifungal agents, prostaglandin and corticosteroids have all failed. Interestingly corticosteroid rescue treatment in the late phase of ARDS has shown promise. Antiendotoxin and anticytokine studies which began with much enthusiasm is yet to produce desirable results.
    Matched MeSH terms: Fluid Therapy
  17. Ramanathan M, Teng TL
    Med J Malaysia, 1991 Sep;46(3):283-6.
    PMID: 1839926
    We present a young lady who satisfied the criteria for the diagnosis of toxic-shock syndrome (TSS). The differential diagnoses of TSS in the local setting are outlined. The pertinent clinical features of TSS and its increasing association with nonmenstruating females are highlighted.
    Matched MeSH terms: Fluid Therapy
  18. Prabhu SP, Nileshwar A, Krishna HM, Prabhu M
    Niger J Clin Pract, 2021 Nov;24(11):1682-1688.
    PMID: 34782509 DOI: 10.4103/njcp.njcp_30_20
    Background: Stroke volume variation (SVV) is a dynamic indicator of preload, which is a determinant of cardiac output. Aims: Aim of this study was to evaluate the relationship between changes in SVV and cardiac index (CI) in patients with normal left ventricular function undergoing major open abdominal surgery.

    Patients and Methods: Patients undergoing major open abdominal surgery were monitored continuously with FloTrac® to measure SVV and CI along with standard monitoring. Both SVV and CI were noted at baseline and every 10 min thereafter till the end of surgery and were observed for concurrence between the measurements.

    Results: 1800 pairs of measurement of SVV and CI were obtained from 60 patients. Mean SVV and CI (of all patients) measured at different time points of measurement showed that as SVV increased with time, the CI dropped correspondingly. When individual readings of CI and SVV were plotted against each other, the scatter was found to be wide, reiterating the lack of agreement between the two parameters (R2 = 0.035). SVV >13% suggesting hypovolemia was found at 207 time points. Of these, 175 had a CI >2.5 L/min/m2 and only 32 patients had a CI <2.5 L/min/m2.

    Conclusion: SVV, a dynamic index of fluid responsiveness can be used to monitor patients expected to have large fluid shifts during major abdominal surgery. It is very specific and has a high negative predictive value. When SVV increases, CI is usually maintained. Since many factors affect SVV and CI, any increase in SVV >13%, must be correlated with other parameters before administration of the fluid challenge.

    Matched MeSH terms: Fluid Therapy*
  19. Passmore MR, Obonyo NG, Byrne L, Boon AC, Diab SD, Dunster KR, et al.
    Thromb Res, 2019 Apr;176:39-45.
    PMID: 30776686 DOI: 10.1016/j.thromres.2019.02.015
    INTRODUCTION: Fluid resuscitation is a cornerstone of severe sepsis management, however there are many uncertainties surrounding the type and volume of fluid that is administered. The entire spectrum of coagulopathies can be seen in sepsis, from asymptomatic aberrations to fulminant disseminated intravascular coagulation (DIC). The aim of this study was to determine if fluid resuscitation with saline contributes to the haemostatic derangements in an ovine model of endotoxemic shock.

    MATERIALS AND METHODS: Twenty-one adult female sheep were randomly divided into no endotoxemia (n = 5) or endotoxemia groups (n = 16) with an escalating dose of lipopolysaccharide (LPS) up to 4 μg/kg/h administered to achieve a mean arterial pressure below 60 mmHg. Endotoxemia sheep received either no bolus fluid resuscitation (n = 8) or a 0.9% saline bolus (40 mL/kg over 60 min) (n = 8). No endotoxemia, saline only animals (n = 5) underwent fluid resuscitation with a 0.9% bolus of saline as detailed above. Hemodynamic support with vasopressors was initiated if needed, to maintain a mean arterial pressure (MAP) of 60-65 mm Hg in all the groups.

    RESULTS: Rotational thromboelastometry (ROTEM®) and conventional coagulation biomarker tests demonstrated sepsis induced derangements to secondary haemostasis. This effect was exacerbated by saline fluid resuscitation, with low pH (p = 0.036), delayed clot initiation and formation together with deficiencies in naturally occurring anti-coagulants antithrombin (p = 0.027) and Protein C (p = 0.001).

    CONCLUSIONS: Endotoxemia impairs secondary haemostasis and induces changes in the intrinsic, extrinsic and anti-coagulant pathways. These changes to haemostasis are exacerbated following resuscitation with 0.9% saline, a commonly used crystalloid in clinical settings.

    Matched MeSH terms: Fluid Therapy
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